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Peer-reviewedCC BY 4.0Frontiers in Endocrinology

Distribution characteristics of initial lesion sites for diabetic foot ulcers in China: a national multicenter survey

  • Yingzhou Shi1
  • Tao Xue2
  • Liren Ma3
  • Lijun Zou4
  • Kexin Li5
  • Yanxiang Wu6
  • Qiuhong Zhou7,8
  • Yanmei Yu9
  • Xiaorui Jiang10
  • Lin Li11
  • Jingyi Zhang12
  • Huifeng Zhang13
8 more authors
  • Penghua Wang14
  • Bingquan Yang15
  • Hong Zhu16
  • Aihong Wang17
  • Yufeng Jiang18
  • Zhangrong Xu17
  • Xingwu Ran19
  • Qiu Li1
19 affiliations
  1. 1Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
  2. 2Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences
  3. 3Department of Peripheral Vascular Disease, Pingdingshan Traditional Chinese Medicine Hospital
  4. 4Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology
  5. 5Department of Endocrinology, Jilin Province People’s Hospital
  6. 6Department of Endocrinology, Air Force Hospital of Northern Theater Command of PLA
  7. 7Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University
  8. 8National Clinical Research Center for Geriatric Diseases, Xiangya Hospital of Central South University
  9. 9Department of Endocrinology, Mudanjiang Cardiovascular Hospital
  10. 10Department of Endocrinology and Foot & Ankle Surgery, Yantai Yuhuangding Hospital, Qingdao University
  11. 11Department of Endocrinology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
  12. 12Department of Endocrinology, Kailuan General Hospital Affiliated to North China University of Science and Technology
  13. 13Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University
  14. 14Department of Diabetic Foot, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University
  15. 15Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University
  16. 16Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University
  17. 17Department of Endocrinology, The Ninth Medical Center, Chinese PLA General Hospital
  18. 18Department of Tissue Repair and Regeneration, Chinese PLA General Hospital
  19. 19Department of Endocrinology and Metabolism, Innovation Center for Wound Repair, Diabetic Foot Care Center, West China Hospital, Sichuan University
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Abstract

Aims: Systematic data on initial diabetic foot ulcer (DFU) locations in China remain limited. We investigated the distribution of initial DFU sites and precipitating factors, together with secondary associations of recorded anatomical site involvement with diabetic peripheral neuropathy (DPN) and lower extremity arterial disease (LEAD).

Methods: This multicenter cross-sectional analysis used an analytical database containing 3,105 records from 2,892 patients recruited at 77 Chinese hospitals (October 2020-April 2022). The earliest dated record was selected for each patient. Physicians recorded, using a 56-region foot classification, the sites where the ulcer first appeared (7,813 site entries from 2,892 patients). Secondary patient-level associations were estimated using age- and sex-adjusted logistic regression with hospital-cluster-robust standard errors.

Results: Among 2,892 patients, the most frequent initial-site categories were between toes (1,102/2,892, 38.1%), dorsum of toe (883/2,892, 30.5%), and toe tip (770/2,892, 26.6%). In secondary analyses, right-foot sole involvement was more frequent than left-foot involvement (5.91% vs 4.32%; FDR-adjusted q=0.034), whereas right-foot toe-tip involvement was less frequent (11.89% vs 14.80%; q=0.022). Leading precipitating factors were accidental injuries (32.2%), footwear-related injury (25.4%), and unidentified causes (16.0%). LEAD alone was associated with dorsal-toe involvement (OR = 1.71, 95% CI 1.30-2.24; q=0.002), while DPN alone was associated with heel involvement (OR = 1.83, 95% CI 1.22-2.76; q=0.015).

Conclusions: This multicenter cross-sectional study characterizes the distribution of initial DFU sites and precipitating factors in China and identifies secondary site-specific neurovascular associations that may inform targeted prevention.

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Cite

BibTeXRIS
BibTeX
@article{shi2026distribution,
  title = {{Distribution characteristics of initial lesion sites for diabetic foot ulcers in China: a national multicenter survey}},
  author = {Yingzhou Shi and Tao Xue and Liren Ma and Lijun Zou and Kexin Li and Yanxiang Wu and Qiuhong Zhou and Yanmei Yu and Xiaorui Jiang and Lin Li and Jingyi Zhang and Huifeng Zhang and Penghua Wang and Bingquan Yang and Hong Zhu and Aihong Wang and Yufeng Jiang and Zhangrong Xu and Xingwu Ran and Qiu Li},
  journal = {Frontiers in Endocrinology},
  year = {2026},
  month = oct,
  doi = {10.3389/fendo.2026.1983798},
  url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1983798/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Distribution characteristics of initial lesion sites for diabetic foot ulcers in China: a national multicenter survey
AU  - Yingzhou Shi
AU  - Tao Xue
AU  - Liren Ma
AU  - Lijun Zou
AU  - Kexin Li
AU  - Yanxiang Wu
AU  - Qiuhong Zhou
AU  - Yanmei Yu
AU  - Xiaorui Jiang
AU  - Lin Li
AU  - Jingyi Zhang
AU  - Huifeng Zhang
AU  - Penghua Wang
AU  - Bingquan Yang
AU  - Hong Zhu
AU  - Aihong Wang
AU  - Yufeng Jiang
AU  - Zhangrong Xu
AU  - Xingwu Ran
AU  - Qiu Li
PY  - 2026
DA  - 2026/10/21
JO  - Frontiers in Endocrinology
DO  - 10.3389/fendo.2026.1983798
UR  - https://www.frontiersin.org/articles/10.3389/fendo.2026.1983798/full
AB  - Aims: Systematic data on initial diabetic foot ulcer (DFU) locations in China remain limited. We investigated the distribution of initial DFU sites and precipitating factors, together with secondary associations of recorded anatomical site involvement with diabetic peripheral neuropathy (DPN) and lower extremity arterial disease (LEAD).  Methods: This multicenter cross-sectional analysis used an analytical database containing 3,105 records from 2,892 patients recruited at 77 Chinese hospitals (October 2020-April 2022). The earliest dated record was selected for each patient. Physicians recorded, using a 56-region foot classification, the sites where the ulcer first appeared (7,813 site entries from 2,892 patients). Secondary patient-level associations were estimated using age- and sex-adjusted logistic regression with hospital-cluster-robust standard errors.  Results: Among 2,892 patients, the most frequent initial-site categories were between toes (1,102/2,892, 38.1%), dorsum of toe (883/2,892, 30.5%), and toe tip (770/2,892, 26.6%). In secondary analyses, right-foot sole involvement was more frequent than left-foot involvement (5.91% vs 4.32%; FDR-adjusted q=0.034), whereas right-foot toe-tip involvement was less frequent (11.89% vs 14.80%; q=0.022). Leading precipitating factors were accidental injuries (32.2%), footwear-related injury (25.4%), and unidentified causes (16.0%). LEAD alone was associated with dorsal-toe involvement (OR = 1.71, 95% CI 1.30-2.24; q=0.002), while DPN alone was associated with heel involvement (OR = 1.83, 95% CI 1.22-2.76; q=0.015).  Conclusions: This multicenter cross-sectional study characterizes the distribution of initial DFU sites and precipitating factors in China and identifies secondary site-specific neurovascular associations that may inform targeted prevention.
SN  - 1664-2392
ER  -